Family reports of pain in dying hospitalized patients: a structured telephone survey.
(41/1291)
OBJECTIVES: To see how often families in Oregon reported moderate to severe pain in dying patients in late 1998 compared with late 1997. DESIGN: A systematic random sample of death certificates was used to identify family members of decedents who died in a hospital setting between October 1 and December 31, 1998. A structured telephone interview was used to obtain data. PARTICIPANTS: Family members of 103 decedents (who died in hospitals 2 to 4 months before data collection) were identified with the use of death certificates. RESULTS: In late 1998, 56 family members (54%) reported that their loved one experienced moderate to severe pain in the last week of life. CONCLUSIONS: Family reports of moderate to severe pain in dying hospitalized Oregonians remain high. The influence of environmental factors on pain management may have implications for practice and policy nationwide. (+info)
Prevalence and correlates of preventive care among adults with diabetes in Kansas.
(42/1291)
OBJECTIVE: To assess the prevalence and correlates of recommended preventive care among adults with diabetes in Kansas. RESEARCH DESIGN AND METHODS: A cross-sectional telephone survey was conducted among a sample of adults (> or = 18 years of age) with self-reported diabetes. Recommended preventive care was defined based on four criteria: number of health-care provider (HCP) visits per year (> or = 4 for insulin users and > or = 2 for nonusers), number of foot examinations per year (> or = 4 for insulin users and > or = 2 for nonusers), an annual dilated eye examination, and a blood pressure measurement in the past 6 months. RESULTS: The mean age of the 640 respondents was 61 years, 58% were women, and 86% were white. In the preceding year, 62% of respondents reported the appropriate number of visits to a HCP 27% the appropriate number of foot examinations, 65% an annual dilated eye examination, and 89% a blood pressure measurement in the preceding 6 months. Only 17% (95% CI 14-20) met all four criteria for recommended care. The adjusted odds of receiving recommended care were higher for males than for females (odds ratio [OR] 1.6; 95% CI 1.1-2.5), higher for people whose HCP scheduled follow-up appointments than for those who self-initiated follow-up (OR 2.7; 95% CI 1.6-4.8), and higher for former smokers than for current smokers (OR 3.1; 95% CI 1.6-6.9). CONCLUSIONS: Preventive care for people with diabetes is not being delivered in compliance with current guidelines, especially for women and current smokers. Scheduling follow-up visits for patients, targeting certain high-risk populations, and developing protocols to improve foot care may be effective in improving care. (+info)
Identifying industrial sites with potential for residential exposure to asbestos.
(43/1291)
BACKGROUND: Non-occupational exposure to asbestos has been of increasing interest, but residential exposure to asbestos often focuses on a few high-profile asbestos users. This study aimed to identify industrial sites producing asbestos goods in a given area and time period. METHODS: A search of trade directories was carried out for industrial sites in West Yorkshire, England, where asbestos may have been used this century. RESULTS: A large number of factories with potential for residential exposure were found. A total of 269 factories in West Yorkshire used asbestos between 1900 and 1979, many for short periods only. CONCLUSIONS: Identification of potential sources of residential exposure to asbestos would have greatly underestimated their number if either only high-profile users or existing official listings had been used. Any consideration of asbestos use should aim to identify all users, not just the high-profile manufacturers. (+info)
Patient satisfaction with out-of-hours services; how do GP co-operatives compare with deputizing and practice-based arrangements?
(44/1291)
BACKGROUND: Although the rapid growth in general practitioner (GP) co-operatives has met with GP satisfaction, little is known about patient satisfaction. This study compares patient satisfaction with co-operative, GP practice-based and deputizing arrangements within one geographical area 15 months after a co-operative had become established; and with telephone, primary care centre and home consultations within the co-operative. METHODS: A validated postal questionnaire survey of weighted samples of patients making contact with the co-operative, practice-based and deputizing arrangements was undertaken. RESULTS: A total of 1,823 (53.2 per cent) patients responded. There were no significant differences between organizations in terms of overall satisfaction, but patients using practice-based arrangements were significantly more satisfied with the waiting time for telephone consultations (p<0.001) and more satisfied with waiting times for home visits than deputizing patients (p=0.020). Within the co-operative, overall satisfaction, satisfaction with the doctor's manner and with the process of making contact was greater among those attending the primary care centre, and satisfaction with explanation and advice received greater than for patients receiving telephone consultations alone (p<0.01). Those receiving telephone advice reported increased information needs and help seeking during the following week (p< 0.05). CONCLUSIONS: Overall, patients were as satisfied with the co-operative as with practice-based or deputizing service arrangements, although many concerns were expressed about the quality of service provision. Differences in satisfaction were greater between forms of service delivery within the co-operative. Dissatisfaction with telephone consultations needs to be considered, together with issues relating to equity in access to out-of-hours' primary care centre consultations and the potential impact of NHS Direct. (+info)
Effect of providing cancer patients with the audiotaped initial consultation on satisfaction, recall, and quality of life: a randomized, double-blind study.
(45/1291)
PURPOSE: By means of a randomized double-blind study, the effect of providing taped initial consultations on cancer patients' satisfaction, recall, and quality of life was investigated. PATIENTS AND METHODS: Consecutive cancer patients referred to either the gynecology or medical oncology outpatient clinic were eligible. Initial consultations were audiotaped. Patients were either provided with the tape (experimental group) or not (control group). Baseline variables included sociodemographics, preferences for information, coping styles, and clinical characteristics. Follow-up (after 1 week and 3 months) variables included attitudes toward the intervention, satisfaction, recall, and quality of life. Assessments took place through mailed questionnaires and telephone interviews. RESULTS: Two hundred one patients were included (response, 71%), 105 in the experimental group and 96 in the control group. Most patients (75%) listened to the tape, the majority of which (73%) listened with others. Almost all patients, both in the experimental group (96%) and control group (98%) were positive about the intervention. Expectations were confirmed; patients provided with the tape were more satisfied (P <.05) and recalled more information (P <.01) than patients without the tape. The intervention did not have an effect on quality of life. An interaction effect was found between the intervention and patients' age on satisfaction with the taped consultation (P <.01) and recall of diagnostic information (P <.01); access to tapes seems more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients. CONCLUSION: Cancer patients and their families value the taped initial consultation. This intervention enhances their satisfaction and improves their recall of information. Tapes seem more helpful in enhancing satisfaction in younger patients and recall of diagnostic information in older patients. (+info)
Patients' knowledge and attitude towards treatment and control of hypertension: a nation-wide telephone survey conducted in Malaysia.
(46/1291)
The telephone survey of 2,526 hypertensive subjects showed 94% of the respondents were aware of the importance in controlling hypertension. Among these 504 were not on anti-hypertensive medication while the majority of 2,022 were currently on anti-hypertensive medication. Of those who were not on medication, 80% (n = 403) were found non-hypertensive on follow-up. The remaining 20% (n = 101) were confirmed hypertensive and were offered medication. However, 38 subjects refused to take medication and 63 subjects complied with medication but subsequently gave up. The main reasons for giving up medication included lack of motivation (38%), doctors' advice (20%), side effects (19%) and concern of side effects (10%). Of 2,022 hypertensive respondents who were currently on medication, almost half (44%, n = 890) required a change of medication due to side effects (40%, n = 356) or the blood pressure not controlled with the previous medication (33%, n = 294). Despite the change in medication, 42% (n = 150) still continued to suffer from some form of side effects. The information obtained from this survey suggested it is important to recommend some strategies to improve patient compliance. These strategies comprise of motivating the patient, improving medication with less side effects, improving potency and efficiency of medication, and reduction of cost in medication. In addition, convenient blood pressure monitoring such as home blood pressure monitoring is also encouraged. (+info)
Interruptions to the physician-patient encounter: an intervention program.
(47/1291)
BACKGROUND: Israeli physicians are very familiar with the problem of interruptions during encounters with patients. However, a thorough search of the medical literature revealed only one report of this problem from Israel, and none from other countries. OBJECTIVES: To characterize the phenomenon of interruptions to the patient-physician encounter in a clinic in Dimona and to assess the effect of an intervention program designed to reduce the magnitude of this problem. METHODS: During an 8 day work period in March 1997 all patient-physician encounters were recorded and characterized. An intervention program was then designed and implemented to reduce the number of interruptions. Data were again collected a year after the initial data collection. RESULTS: During the 8 day study period prior to the intervention program there were 528 interruptions to 379 encounters (mean of 1.39 per encounter). The main causes of interruptions were entrance of uninvited patients to the examination room (31%) and telephone calls (27%). Most of the interruptions occurred during the morning hours between 8 and 10 a.m. (45%) and at the beginning of the week (Sunday 30%). After the intervention program there were 402 interruptions to 355 encounters (mean of 1.13 per appointment, P = 0.21). CONCLUSIONS: There was no statistically significant improvement in the number of interruptions following the intervention program. This finding is either the result of a local cultural phenomenon, or it indicates a national primary care health system problem that may require a long-term educational program to resolve it. Further research is needed on the magnitude, causes and consequences of interruptions in family practice and, if warranted, methods will have to devised to cope with this serious problem. (+info)
Intimate partner violence prevalence estimation using telephone surveys: understanding the effect of nonresponse bias.
(48/1291)
To assess the effect of nonresponse bias in telephone prevalence studies of intimate partner violence, the authors asked women visiting a health center in Albany, New York, during 1998 about their willingness to participate in telephone surveys. Women physically victimized by a male partner were more likely than other women to say they would participate in telephone surveys (66.7% vs. 44.4%, p = 0.03). Among women severely victimized, those living with their partner were less willing to participate than those not cohabiting (45.5% vs. 91.7%, p = 0.03). Including questions about willingness to participate in telephone surveys in studies of other kinds may be a useful method of identifying nonresponse bias. (+info)